Women's Health

Study Finds Incontinence in Women Somewhat Common

Almost 25 percent of American women have a pelvic floor disorder, such as urinary incontinence, fecal incontinence, or pelvic organ prolapse, according to a study in the Journal of the American Medical Association (JAMA).

"This study showed that pelvic floor disorders are exceedingly common in women in the United States," says the study's lead author, Dr. Ingrid Nygaard, of the University of Utah.

And, though these disorders are prevalent, women do not always bring them up with their doctors, notes Dr. Nygaard. "Pelvic floor disorders are not talked about often, and women are often too embarrassed to bring them up."

Dr. Victor Nitti, of New York University, says, "I don't think there's any question that pelvic floor disorders are underreported. Some women are embarrassed, and some think they're a normal part of aging. Either way, it's not something women will often report spontaneously."

More than a Leak when Laughing

The new study reviewed data from almost 2,000 women over the age of 20 who had participated in the 2005-2006 National Health and Nutrition Examination Survey.

This study group is considered to be representative of the US population. None of the women included in the data analysis was pregnant at the time of the study.

The women were interviewed at home and underwent a physical exam in a mobile examination center.

Urinary incontinence was diagnosed based on scoring more than "three" on an incontinence severity index. Fecal incontinence was diagnosed if women reported having at least one monthly leakage of stool.

Pelvic organ prolapse was diagnosed if women reported feeling a bulge inside or outside of the vagina. (Pelvic organ prolapse occurs when one of the pelvic organs, such as the uterus, drops and presses on the vagina.)

Dr. Nygaard points out that this study looked at moderate to severe incontinence. She says it is quite common for women to leak small amounts of urine while laughing or sneezing, but that is not what was studied.

Older women were most likely to report a pelvic floor disorder, with almost 50 percent of those 80 and older reporting at least one pelvic floor disorder, compared to just 10 percent of women between 20 and 39 years old.

Having been pregnant increased the odds of pelvic floor disorders, and, with each pregnancy, the likelihood of incontinence or prolapse rose. Similarly, being overweight or obese also increased the risk of pelvic floor disorders, according to the study.

Muscle Strengthening, Medication Helps

Both Drs. Nygaard and Nitti say that effective treatments are available for women with pelvic floor disorders.

Dr. Nygaard recommends that women start with the most conservative treatment options, such as pelvic muscle strengthening and behavioral therapy.

Surgery, which can be effective for certain problems, is usually reserved as a last option, she explains.

"The most important thing women need to realize is that they're not alone. Pelvic floor disorders aren't dangerous and are treatable," says Dr. Nygaard.

Dr. Nitti adds: "If you have any symptoms related to any of these problems, and they bother you, you shouldn't be embarrassed to bring it to the attention of your health-care providers. All are, in one way or another, treatable, particularly at the early stages."

Always consult your physician for more information.

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December 2008

Facts about Urinary Incontinence

Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom.

More than 15 million men and women in the United States experience incontinence. UI can strike at any age. Women over age 50 are the most likely to develop UI.

Urinary incontinence may be a temporary condition, resulting from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.

Incontinence is not an inevitable result of aging, but is particularly common in older people.

It is often caused by specific changes in body function that may result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection.

Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.

The following are some of the different types of urinary incontinence:

urge incontinence - the inability to hold urine long enough to reach a restroom. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis, but may be an indication of other diseases or conditions that would also warrant medical attention.

stress incontinence - the most common type of incontinence that involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder.

functional incontinence - leakage due to a difficulty reaching a restroom in time because of physical conditions such as arthritis.

overflow incontinence - leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold it.

The following are the most common symptoms of urinary incontinence. However, each individual may experience symptoms differently.

Symptoms may include:

inability to urinate

pain related to filling the bladder and/or pain related to urination without a proven bladder infection

progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying

an increased rate of urination without a proven bladder infection

needing to rush to the restroom and/or losing urine if you do not get to restroom in time

abnormal urination or changes in urination related to a nervous system

abnormality such as stroke, spinal cord injury, multiple sclerosis

leakage of urine that prevents activities

leakage of urine that began or continued after surgery

leakage of urine that causes embarrassment

frequent bladder infections

The symptoms of urinary incontinence may resemble other conditions or medical problems.